Determining success of attitude change prgrams: A focus on safe sex

Abstract

The prevalence of Sexually Transmitted Diseases (STI) is on the rise. An increase in the number of sexual partners and a younger age of initiating sexual intercourse are factors contributing to this increase. The use of condoms can greatly minimise the spread of STIs, however, many people still do not use them. There are many health campaigns worldwide aimed at encouraging preventive behaviours to reduce the prevalence of STIs. The success of a health campaign can be assessed based on how effectively it uses the principles of the Health Belief Model. Cognitive dissonance is helpful in provoking a need for change and persuasion techniques can influence this change towards preventive health behaviours.

Introduction

As health is very important for quality of life, there are many health promotion campaigns in today’s society to try to improve the health of individuals. The success of a health campaign to change an individual’s attitudes towards preventive health behaviours requires a campaign to encompass many variables. An individual’s beliefs are greatly reflected in their behaviour and attitudes and so a change in beliefs may be imperative to attitude change and therefore behaviour. The Health Belief Model (HBM) is one of many theoretical concepts which can be used to assess the likelihood of success of a health campaign in changing risk health behaviours into preventive behaviours. The HBM consists of five core beliefs of an individual towards health; these are; perceived susceptibility, perceived severity, benefits of engaging in preventive behaviour, costs of engaging in preventive behaviour and cues to action (Scandell & Wlazelek, 2002). Health campaigns can then invoke cognitive dissonance in the individual around these principles of the HBM, which will then be followed up with persuasion towards healthy beliefs, attitudes and behaviours. NSW Health released a health campaign “Safe Sex. No Regrets”
(http://www.health.nsw.gov.au/sexualhealth/campaigns.html), this example will be assessed on its likelihood of successfully changing attitudes towards condom use, for the prevention of sexually transmitted infections (STI).

The Health Belief Model

The Health Belief Model consists of five core beliefs an individual has towards health; these are; perceived susceptibility, perceived severity, benefits of engaging in preventive behaviour, costs of engaging in preventive behaviour and cues to action (Scandell & Wlazelek, 2002). If the “Safe Sex. No Regrets” campaign is to be successful it would need to persuade individuals that; they are highly susceptible to STIs, STIs are severe and that the benefits of using condoms out way the costs of using them. A health campaign itself could be considered a cue to action, through providing education and awareness (Ogden, 2004). Another cue to action could be experiencing a symptom of an STI. The information brochure for this campaign provides information from which an individual could recognise their symptoms as having an STI.

The “Safe Sex. No Regrets” campaigns brochure (NSW Health) states that “genital warts are very common in Australia” (page 4), “STIs and HIV exist in all countries and cultures and can affect anyone” (page 10) and “thinking ‘it won’t happen to me’ provides no protection” (page 10). These statements aim to increase the awareness of susceptibility in society but also for the individual themselves. Furthermore, by refuting the common belief that ‘it won’t happen to me’ increases the perceived susceptibility because STIs are common, this cannot apply to all people. Another issue is their perceived likelihood that the other person they are engaging with will have an STI (Browes, 2006). This campaign states ‘You can’t tell whether someone has an STI based on how they look, dress, behave or who they have slept with’ (page 10) this aims to reduce the belief that the other person is unlikely to have an STI. The television campaign also displays typical young adults dancing in a typical night club scene, which implies that they could be carrying an STI, just as anyone could. A problem with statements such as ‘very common in Australia’ could be that as STIs are social undesirable, it is an unlikely topic to be discussed with many people and so people may not believe STIs are very common as they do not know anyone who they think has had one. A very important task for this campaign is that it educates that using condoms will decrease the likelihood of susceptibility of STIs. If this is not achieved it would be unlikely that people will use condoms.

A belief that STIs are severe is likely to increase the likelihood of using condoms. While this campaign provides descriptions of symptoms which are undesirable, another technique in other campaigns is to provide pictures of diseases, such as, genital warts in extreme cases to increase perceived severity. Explaining that STIs often have no symptoms but if they progress can result in infertility, may increase perceived severity. One problem with promoting severity is that there is also a need to educate that often STIs are easily treated; this is to encourage STI checks but may decrease the perceived severity of contracting an STI, as it is easily fixed. However, some STIs would be more undesirable than others, (the ones which are hard to cure) but as you cannot choose or know which one you will get you need to use condoms to prevent against all. Severity may also be viewed in relation to social aspects. If an STI is contracted and has obvious symptoms how is this going to affect future relationships?

While it is quite obvious that the benefits of using condoms is not contracting an STI and the cost of not using one would be an increased possibility of contracting an STI there are many other factors. Peer pressure can play a role, as normative influence may prevent asking a partner to use a condom and also because it requires self-efficacy (Doheny, Sedlack, Estok & Zeller, 2007). Other barriers could include; alcohol use, access to condoms and gender roles – believing it is the other genders role to bring a condom (Boone & Lefkowitz, 2004). Success of a campaign could be gained through promoting that belief condom use is a social norm and minimising any stigma behind it.

Several studies have found that perceived susceptibility of contracting an STI is the best predictor of condoms use (Denny-Smith, Bairan & Page, 2006; Scandell & Wlazelek, 2002, Browes, 2006). This campaign provides awareness which in itself could increase perceived susceptibility, as people will know STIs are prevalent in society.

Cognitive Dissonance

For an attitude change campaign to be successful it may need to induce cognitive dissonance within the individual in relation to the core beliefs of the HBM. Cognitive dissonance is the presence of discomfort that has resulted from holding inconsistent cognitions, which can result in motivation to reduce discomfort by aligning cognitions (Gosling, Denizeau & Oberle, 2006). A health campaign may provide information which is inconsistent with the current risk taking behaviour. This inconsistency usually results changing attitudes to be in line with behaviour (Norton, Cooper, Monin & Hogg, 2003). Therefore a change in attitude (and behaviour) can occur through a change in beliefs. Persuasion techniques can be helpful to do this.

Persuasion

There are many persuasion techniques, which, when used together may increase effectiveness. Credibility, fear and repetitiveness are three examples of persuasion.

Credibility: the credibility of the source providing the information has been found to be a higher predictor of persuasion. When the source is considered to have expertise and trustworthiness, persuasion is likely (Umeb & Stanley, 2005). Tormala, Brinol and Petty, (2007) stated that people expect expert sources to have more valid arguments which creates a positive bias towards their information. The “Safe Sex. No Regrets” campaign is a government initiative, which for many would indicate expertise and trustworthiness.

Fear: the use of fear in health campaigns is used to invoke a negative emotion into the individual, who will then be motivated to reduce this negative emotion, by engaging in behaviour which will prevent this emotion (Lewis, Watson, White & Tay, 2007). Baumeister and Bushman, (2008) report that a picture along with written text, was 60 times more inspiring to change behaviour then just written text alone. This is believed to be because the picture shows that participating in preventive behaviour will avoid the situation in the picture. This technique is not used in the “Safe Sex. No Regrets” campaign, however, as previously stated other campaigns use pictures of diseases, such as, genital warts in extreme cases, to invoke fear, to influence preventive behaviours.

Repetition: Repetition can be useful in health campaigns for several reasons; mere exposure effect that familiarity breeds liking, increased memory and increases understanding through deeper thought processes (Cacioppo & Petty, 1989). The “Safe Sex. No Regrets” campaign in its brochure states on every page that condom use will minimise risk of contracting STI. This is repeated as it is the most important message and so it is essential to be remembered.

Conclusion

Attitude change can be a difficult task. The Health Belief Model provides core principles which health campaigns need to address to change health behaviours. Cognitive dissonance can invoke a negative state which may motivate an individual to change attitudes and behaviours. During this change, a health campaign can provide persuasion towards preventive health behaviours. A health campaign is one influence towards attitude change. However, there are also many other socio-psychological factors which contribute to attitude change, as outlined in the concept map.


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